Upright x-ray breast imaging with a ct mode, multiple tomosynthesis modes, and a mammography mode

ABSTRACT

A multi-mode system and method for imaging a patient&#39;s breast with x-rays in one or more of a CT mode, a narrow-angle tomosynthesis mode, a wide angle tomosynthesis mode, and a mammography mode, using essentially the same equipment, on one or more compressions or immobilizations of the breast.

FIELD

This patent specification pertains to x-ray imaging of the breast and,more specifically, to a system for selectively imaging a breast of anupright patient in one or more of a CT mode, one or more tomosynthesismodes (e.g., narrow angle breast tomosynthesis and wide angle breasttomosynthesis), and a mammography mode. The system preferably isintegrated so that the equipment can be used for any one or more ofthese imaging modes. The patient can be standing, as is typical formammography and tomosynthesis, rather than lying down as in conventionalCT. In the CT mode, the imaging x-ray beam passes only through thebreast, not through the patient's torso as when a conventional CT systemis used to image the breast.

BACKGROUND

X-ray mammography is the established screening modality for breastcancer and other lesions, and also has been relied on for diagnostic andother purposes. Historically, the breast image has been recorded onx-ray film but more recently digital x-ray image receptors have comeinto wide use, as in the mammography system available under the tradename Selenia from the common assignee hereof, Hologic Inc. of Bedford,Mass., and from its division Lorad Corporation of Danbury, Conn. Inmammography, typically a pyramid-shaped x-ray beam passes through thecompressed breast and forms a two-dimensional projection image, namely,a mammogram identified herein as images M. Any one of a number oforientations can be used, such as CC (cranial-caudal) or MLO(mediolateral-oblique).

More recently, breast x-ray tomosynthesis has come into use. The commonassignee has installed breast tomosynthesis systems for clinical use inthis country and has sold such systems overseas. The technologytypically involves taking two-dimensional (2D) projection images,identified herein as images Tp, of the immobilized breast at each of anumber of angles of the x-ray beam relative to the breast. The resultingx-ray measurements are computer-processed to reconstruct images,identified herein as images Tr, of breast slices that, typically are inplanes transverse to the x-ray beam axis, such as parallel to the imageplane of a mammogram of the same breast, but can be at any otherorientation and can represent breast slices of selected thicknesses. Therange of angles is substantially less than in conventional CT(computerized tomography), i.e. substantially less than 180° plus a fanangle, e.g., a range of ±15°.

An example of a breast x-ray tomosynthesis system is the commonassignee's system available under the trade name Selenia Dimensions thatis sold overseas and has been installed for clinical testing in thiscountry and includes both a tomosynthesis mode of operation and amammogram mode of operation. See also U.S. Pat. No. 7,123,684 and U.S.patent application publications 2005/0113681 A1 and 2009/0003519 A1,U.S. Pat. Nos. 4,496,557, 5,051,904, 5,359,637, 6,289,235, 6,375,352,6,645,520, 6,647,092, 6,882,700, 6,970,531, 6,940,943 7,356,113,7,656,994, published U.S. Patent Applications Nos. 2004/0066904 and2007/0263765, and Digital Clinical Reports, Tomosynthesis (GE Brochure98-5493, November 1998). How to reconstruct tomosynthesis images isdiscussed in DO Grant, “Tomosynthesis: a three-dimensional imagingtechnique”, IEEE Trans. Biomed. Engineering, Vol BME-19, #1, (January1972), pp 20-28. See, also, U.S. Provisional Application No. 60/628,516,filed Nov. 15, 2004, and entitled “Matching geometry generation anddisplay of mammograms and tomosynthesis images,” and a system announcedunder the name Giotto Image 3D by a I.M.S. Intemazionale MedicoScintifica of Bologna, Italy. Mammography and tomography systems canalso be used in interventional procedures, such as biopsy, by adding abiopsy station (for example, the system available from the commonassignee under the trade name StereoLoc II Upright Stereotactic BreastBiopsy System). The patents, applications, brochures, and article citedabove, as well as those cited below, are hereby incorporated byreference in this patent specification as though fully set forth herein.

X-ray breast imaging systems that can selectively take tomosynthesisprojection images and conventional mammograms, such as the systemavailable under the trade name Selenia Dimensions system, are known.They include an x-ray source and an x-ray imaging receptor that can beheld in a fixed relationship to each other and moved as a unit to takeconventional mammograms M, and can be decoupled from each other so thatat least one can move relative to the other and to the patient's breastto take tomosynthesis projection images Tp. See also commonly assignedU.S. Pat. No. 7,583,786.

CT technology has not been widely used for x-ray imaging of the breast.In conventional CT, the patient is lying down on a gurney or platformwhile the x-ray source and detectors rotate about the patient. The x-raymeasurements are reconstructed into images, referred herein as imagesCTr, of typically planar slices of the patient. The imaging planes thatintersect the breast also intersect the torso and so the patient's bodyis unnecessarily subjected to x-radiation when only an x-ray image ofthe breast is of interest. In addition, the use of conventional CT forbreast images can be unduly expensive. There have been proposals for CTsystems that would image only the breast, without imaging the torso aswell, but they require the patient to be in a prone position and alsohave not found wide use. See, for example, U.S. Pat. No. 3,973,126,proposing to suspend the breast of a prone patient into an openingaround which an x-ray source and an x-ray detector would rotate in ahorizontal plane. See also U.S. Pat. No. 6,987,831, proposing a verysimilar arrangement that uses more modem components. In addition,published U.S. patent publication 2010/0080343 A1 proposes a breast CTsystem in which the patient's breast protrudes through an opening in avertical wall to thereby extend to the other side of the wall, where agantry rotates an x-ray source and detector in a spiral scan motion orsuccessive slice scan motion to image the protruding portions of thebreast.

It can be desirable for a number of reasons to assess different types ofx-ray images of a patient's breast. For example, over decades of readingconventional mammograms M, medical professionals have developed valuableinterpretation expertise. Mammograms M may offer good visualization ofmicro calcifications, and may offer higher spatial resolution comparedwith tomosynthesis images Tp or Tr. Tomosynthesis images Tr may havedifferent desirable characteristics—e.g., they may offer bettervisualization of structures that can be obscured by overlying orunderlying tissue in a conventional mammogram M. CT images CTr can offerother benefits, such as the ability to obtain attenuation values forspecific tissue inside the breast and to generate a three-dimensionalimage of volume elements (voxels) in the breast that is generally freeof geometric distortions and thus can be conveniently re-processed intoimages of breast slices at any orientation and with any thickness.However, no system is known to the inventors herein that would make itpossible to select which one or more of these three types of breastimages to take with a single system, without moving the patient from oneimaging system to another and perhaps from one medical facility toanother.

It also can be desirable to co-register breast images taken withdifferent x-ray modalities, e.g., so that the same real or suspectedlesion can be viewed and assessed in the images from two or moremodalities, as each modality may contribute different information aboutthe lesion. While some aspects of co-registration have been provided fortomosynthesis images Tr and Tp and mammograms M (see, e.g., commonlyowned U.S. Pat. Nos. 7,577,282 and 7,616,909), no co-registration isknown for x-ray CT breast images, especially if taken from an uprightpatent, with Tr, Tp, and M x-ray images of the breast.

SUMMARY

This patent specification describe-s a multi-mode system that includesan x-ray CT system taking CT breast x-ray images CTr of an uprightpatient positioned with respect to the system in a way similar to apatient's position relative to a conventional mammography system, whileproviding protection from moving assemblies using a design uniquelysuited to x-ray CT scanning of the breast. The same system can beconfigured to selectively take not CT but tomosynthesis images Tp and Trin one of at least two tomosynthesis modes, such as a wide angle modeand a narrow angle mode. And, the same system can be configured toselectively take mammograms M that are essentially the same as, or aresimilar in appearance to, conventional mammograms taken with amammography system. Thus, the same system can operate in any one, or anytwo or more, of several modes for breast imaging: a CT mode, pluraltomosynthesis modes including for example a wide angle tomosynthesismode and a narrow angle tomosynthesis mode, and a mammography mode.Breast images of the patent can be taken in a single one of these modes,or in two or more of these modes, while the patient's breast remainsimmobilized, or in different immobilizations of the breast during thesame study, or at different times. Preferably, the imaging x-rayreceptor is a two-dimensional receptor that can image the entire breastin the mammography mode, so that preferably the same receptor can beused in the CT scan mode in a single rotational motion, thus avoidingthe need to scan multiple times around the breast in order to acquirex-ray measurements for multiple slices of the breast.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 is a perspective view of a portion of an upright breast x-rayimaging system illustrated as operating in a CT mode but also configuredto selectively operate in at least two tomosynthesis modes and amammography mode.

FIG. 2 is a side elevation of the system of FIG. 1.

FIG. 3 is a front elevation illustrating a patient shield for a systemsimilar to that seen in FIGS. 1 and 2.

FIG. 4 is a side elevation that is the same as FIG. 2 but illustrates apatient shield.

FIGS. 5 and 6 are similar to FIGS. 1 and 2, respectively, but illustratethe system as used in a tomosynthesis mode or a mammography mode andshows a gantry that is spaced further from a support column than inFIGS. 2 and 4.

FIG. 7 is a perspective view illustrating an imaging receptor that canpivot inside a receptor housing.

FIG. 8 is a schematic illustration of different path lengths of x-raysthrough a compressed breast of a patient.

FIG. 9 is a block diagram illustrating an integrated x-ray system.

FIGS. 10 and 11 illustrate portions of an alternative embodiment thatmay improve system operation and patient comfort.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

In describing examples and preferred embodiments illustrated in thedrawings, specific terminology is employed for the sake of clarity.However, the disclosure of this patent specification is not intended tobe limited to the specific terminology so selected and it is to beunderstood that each specific element includes all technical equivalentsthat operate in a similar manner.

FIGS. 1 and 2 illustrate portions of a non-limiting example of amulti-mode breast x-ray imaging system operable in a CT mode but alsoconfigured to selectively operate in a tomosynthesis mode including awide angle tomosynthesis mode and a narrow angle tomosynthesis mode, andin a mammography mode. For clarity of illustration, a patient shield foruse in the CT mode is omitted from FIGS. 1 and 2 but examples areillustrated in FIGS. 3, 4, 10 and 11. A support column 100 is secured toa floor and houses a motorized mechanism for raising and lowering ahorizontally extending axle 102, which protrudes through an opening 100a in column 100, and for rotating axle 102 about its central axis. Axle102 in turn supports a coaxial axle 102 a that can rotate with orindependently of axle 102. Axle 102 supports a breast immobilizationunit comprising an upper plate 104 a and a lower plate 104 b such thateach plate can move up and down along the long dimension of support 100together with axles 102 and 102 a, at least one of the plates can movetoward the other, and unit 104 can rotate about the common central axisof axles 102 and 102 a. In addition, axle 102 supports a gantry 106 fortwo types of motorized movement: rotation about the central axis of axle102, and motion relative to axle 102 along the length of gantry 106.Gantry 106 carries at one end an x-ray source such as a shrouded x-raytube generally indicated at 108, and at the other end a receptor housing110 enclosing an imaging x-ray receptor 112 (not visible in FIGS. 1 and2 but illustrated in FIG. 7).

When operating in a CT mode, the system of FIGS. 1 and 2 immobilizes apatient's breast between plates 104 a and 104 b. To this end, unit 104is raised or lowered together with axle 102 to the height of the breastwhile the patient is upright, e.g., standing or sitting. The patientleans toward unit 104 from the left side of the system as seen in FIG.2, and a health professional, typically an x-ray technician, adjusts thebreast between plates 104 a and 104 b while pulling tissue to the rightin FIG. 2 and moving at least one of plates 104 a and 104 b toward theother to immobilize the breast and keep it in place, preferably with asmuch as practicable of the breast tissue being inside unit 104. In thecourse of taking x-ray measurements representing CT projection x-rayimages CT[, from which to reconstruct images CTr of respective breastslices, gantry 106 rotates about the central axis of axle 102 while thebreast remains immobilized in unit 104. Preferably, imaging receptor 112inside housing 110 remains fixed relative to x-ray tube 108 during therotation of gantry 106. A pyramid shaped beam of x-rays from tube 108traverses the breast immobilized in unit 104 and impinges on imagingreceptor 112, which in response generates a respective two-dimensionalarray of pixel values related to the amount of x-ray energy received foreach increment of rotation at respective pixel positions in an imagingplane of the receptor. These arrays of pixel values for images CTp aredelivered to and processed by a computer system (not shown in FIGS. 1and 2 but illustrated in FIG. 9) to reconstruct slice images CTr or thebreast. Gantry 106 may be configured for motorized movement towardcolumn 100, to facilitate the x-ray technician's access to the patient'sbreast for positioning the breast in unit 104, and away from column 100to ensure that x-ray tube 108 and imaging receptor 112 inside housing110 can image the appropriate breast tissue. Alternatively, gantry 106can maintain a fixed distance from column 100, to the left of theposition seen in FIG. 2, so that the imaging x-ray beam can pass throughas much as practical of the breast immobilized in unit 104, in whichcase there would be no need for a mechanism to vary that distance.

A unique challenge arises because of the upright position of the patientand the rotation of x-ray tube 108 and receptor housing 110 through alarge angle in the CT mode of operation. As known, CT scanning typicallyinvolves a rotation of the source and receptor through an angle of 180°plus the angle subtended by the imaging x-ray beam, and preferably arotation through a greater angle, e.g., 360°. However, if the rotationincludes the 0° position of x-ray source 108 as seen in FIGS. 1 and 2,the patient's head may be too close to x-ray source 108. Collision ofrotating assemblies with the patient, and concern with such collision,can be avoided by the use of a shield separating the patient fromassemblies rotating even the full 360, as discussed below in this patentspecification, although depending on the design of the shield and therotating assemblies in particular embodiments this may require thepatient to arch her body such that both her head and legs are away fromthe system, to the left as seen in FIG. 2. An alternative, alsodiscussed below, is to exclude from the rotation a sector or segmentaround the position of x-ray source 108 seen in FIGS. 1 and 2. As anon-limiting example, if the position of x-ray tube 108 seen in FIGS. 1and 2 is designated the 0° position, then the rotation for CT imagingexcludes positions of x-ray source 108 in the 90° sector or segmentbetween 45° and 315°, or in the 120° sector or segment between 60° and300°, or in some other sector or segment that is sufficient to clear thepatient's head position while taking x-ray CT data over a sufficientangle of rotation for the reconstruction of high quality CTr images.While the rotation of x-ray tube 108 and receptor housing 110 still hasto clear the lower part of the patient's body, it is generally easierfor a patient to keep the lower part of her body away from the rotatingcomponents, to the left as seen in FIG. 2 (and preferably behind ashield), than to arch back her head and shoulders.

An example of such a shield is illustrated, in FIGS. 3 and 4. FIG. 4 isa side elevation that is otherwise the same as FIG. 2 but additionallyillustrates a patient shield 114 having a central opening 114 c. Shield114 may be completely circular in front elevation, as illustrated by thecircle that includes an arc in broken line in FIG. 3, in frontelevation. In that case, gantry 106 can rotate through a complete circlein the CT mode. As an alternative, shield 114 can leave open a sector orsegment 114 a illustrated in FIG. 3 as the area below the broken linearc and between the solids line of shield 114. In that case, gantry 106can rotate in the CT mode only through an angle that is less than 360°,but the patient can have space for her head and perhaps a shoulder andan arm in the V-shaped cutout 114 b of shield 114, for a morecomfortable body posture. Specifically, as illustrated in FIG. 3, gantry106 can rotate only within the portion of shield 114 that is outsideV-shaped cutout 114 b. One of the possible positions of gantry 106 andtube 108 and receptor housing 110 is shown in solid lines. Motherpossible position is shown in broken lines, and designated as gantry106′, carrying x-ray source 108′ and receptor housing 110′. FIG. 4illustrates a possible shape of shield 114 in side elevation. Shield 114bulges away from central opening 114 c in a direction away from column100, to allow the patient's breast to reach and become immobilized inunit 104 while the patient's body is separated by shield 114 from therotating components, namely gantry 106 and x-ray source 108 and receptorhousing 110. Opening 114 c may be made larger, and may be shapeddifferently from the illustration in FIGS. 3 and 4 (which are not toscale) to facilitate access by the x-ray technician to the patient'sbreast as the breast is being immobilized. Portions of shield 114 may beremovable or hinged to further facilitate access. For example, one orboth of the portions of shield 114 above broken lines 114 d and 114 emay be removable or hinged such that they can be moved out of the waywhile the technician is positioning and immobilizing the patient'sbreast, and put back to protect the patient before scanning in the CTmode starts. Patient shield can be mounted on column 100 and/or thefloor. In the example of FIGS. 3 and 4, the rotating gantry 106 can bemoved to the left or to the right so that it is closer to or furtheraway from the patient, i.e., from one to the other of the position seenin FIG. 4 and the position seen is FIG. 6. Thus, for CT imaging of thebreast using the example of FIG. 3, rotating gantry 106 would be spacedaway from column 100, to the position relative to column 100 illustratedin FIG. 6 while actually imaging the patient's breast only while thereceptor housing 110 is outside the cutout 114 b. Thus, the patient canlean forward, partly into cutout 114 b so that more of the beast beingimaged, and possibly surrounding tissue, can come into the x-ray imagingfield.

Another challenge in upright breast CT is how to immobilize the breast.In some cases, for various reasons little or no compression of thebreast may be desirable. In other cases, it may be desirable to compressor otherwise act on the breast, for example so that breast tissue can bepulled away from patient's chest wall and securely retained in unit 1.04for imaging. To this end, and to generally increase patient comfort, atleast one, and preferably both, of plates 104 a and 104 b have concavefacing surfaces as seen in FIG. 6 designed to hold the breast for CTimaging while keeping it close to round and thus with close to equalpath lengths of x-rays at least within individual CT slices. Plates 104a and 104 b may be removably secured so that different sets of platescan be used to accommodate differently sized or shaped breasts.Different degrees of breast compression can be used as selected by ahealth professional operating the system of FIGS. 1-4. In still othercases, it may be desirable to use other means to pull breast and chestwall tissue into the x-ray imaging field, such as providing a cup-shapedor funnel-shaped enclosure into which the breast and possiblysurrounding tissue is pulled by vacuum, adhesion or other means,illustrated in block diagram form in FIG. 9.

Yet another challenge in upright breast. CT is that the path lengths ofx-rays through the breast may differ depending on the part of the breastthey traverse. For example, the path lengths through breast portions ator near the nipple may be much shorter than those near the chest wall.When operating in the CT mode, the x-ray technician can shape thepatient's breast as it is being immobilized in unit 104 using an x-raytransparent pillow or similar items to make the breast cross-sectionnearly uniform by pushing the nipple end toward the chest wall andsecuring the so-shaped breast in unit 104, to thus nearly equalize thex-ray path lengths through the breast. As an alternative that does notinvolve so shaping the immobilized breast, a shaped x-ray filter can beused in the housing of x-ray tube 108 to shape the x-ray energydistribution of the imaging x-ray beam so that beam hardness increasesin the direction from the nipple toward the chest wall. As yet anotherapproach, x-ray path lengths can be equalized or at least made moreuniform by a suitably shaped x-ray attenuating material arranged aroundthe breast, in the path of the x-ray beam from the x-ray source.

Use of the system in a tomosynthesis mode is illustrated in FIGS. 5 and6, which are otherwise the same as FIGS. 1 and 2 respectively, exceptthat gantry 106 is in a different position relative to breastimmobilization unit 104 and axle 102 and column 100, and no shield 114is shown. In particular, x-ray source 108 is further from unit 104 andcolumn 100, and receptor housing 110 is closer to unit 104. In thetomosynthesis mode, the patient's breast also is immobilized betweenplates 104 a and 104 b, which remain in place during imaging. In oneexample, x-ray tube 108 and receptor housing 110 may undergo a rotationabout the immobilized breast that is similar to that in the CT modeoperation but is through a smaller angle. A respective two-dimensionalprojection image Tp taken for each increment of rotation while x-raytube 108 and imaging receptor 112 inside housing 110 rotate as a unit,fixed with respect to each other, as in the CT mode or as illustrated inprinciple in commonly assigned U.S. Pat. No. 7,123,684, incorporated byreference. Alternatively, the motions of x-ray tube 108 and receptor 112relative to the immobilized breast can be as in said system offeredunder the trade name Selenia Dimensions of the common assignee, certainaspect of which are described in commonly owned U.S. Pat. No. 7,616,801,which is hereby incorporated by reference. In this alternative case,x-ray tube rotates about the central axis of axle 102, but receptorhousing 110 remains in place while imaging receptor 112 rotates orpivots inside housing 110 about an axis that typically passes throughthe image plane of the receptor, is parallel to the central axis of axle102, and bisects imaging receptor 112. The rotation or pivoting ofreceptor 112 typically is through a smaller angle than the rotationangle of x-ray tube 108, calculated so that a normal to the imagingplane of receptor 112 can continue pointing at or close to the focalspot in x-ray tube 108 from which the imaging x-ray beam is emitted, andso that the beam continues to illuminate all or most of the imagingsurface of receptor 112. In one example of tomosynthesis mode operation,x-ray tube 108 rotates through an arc of about ±15° while imagingreceptor rotates or pivots through about ±5° about the horizontal axisthat bisects its imaging surface. During this motion, plural projectionimages Tp are taken, such as 20 or 21 images, at regular increments ofrotation angle. The central angle of the ±15° arc of x-ray source 108rotation can be the 0° angle, i.e., the position of the x-ray source 108seen in FIGS. 5 and 6, or some other angle, e.g., the angle for thex-ray source position typical for MLO imaging in conventionalmammography. In the tomosynthesis mode, the breast may be immobilized inunit 104 but, alternatively, lower plate 104 b may be removed so thatthe breast is supported between the upper surface of receptor housing110 and upper plate 104 a, in a manner analogous to the way the breastis immobilized in said system offered under the trade name Selenia. Inthe tomosynthesis mode, greater degree of breast compression can be usedunder operator control than in the CT mode. The same concave plates 104a and 104 b can be used, or generally flat plates can be substituted, ora single compression paddle can be used while the breast is supported bythe upper surface of receptor housing 110, as used in said systemoffered under the Selenia trade name.

When operating in a tomosynthesis mode, the system of FIGS. 5 and 6provides multiple choices of that mode, selectable by an operator, forexample a narrow angle mode and a wide angle mode. In the narrow angletomosynthesis mode, x-ray source 108 rotates around unit 104 and thepatient's breast immobilized therein through an angle such as ±15°,while in the wide angle tomosynthesis mode x-ray tube 108 rotatesthrough an angle such as in the range of about ±15° to ±60°. The wideangle mode may involve taking the same number of projection images Tp asthe narrow angle mode, or a greater number. As a non-limiting example,if the narrow angle mode involves taking a total or 20 or 21tomosynthesis projection images Tp as x-ray source 108 moves through itsarc around the breast, the wide angle mode may involve taking the samenumber of images Tp or a greater number, such as 40 or 60 or some othernumber, typically at regular angular increments. The examples of anglesof rotation of x-ray source 108 are not limiting. The important point isto provide multiple modes of tomosynthesis operations, where one modeinvolves x-ray source rotation through a greater angle around the breastthan another tomosynthesis mode.

FIG. 7 illustrates imaging receptor 112 inside receptor housing 110.Receptor 112 can be in a fixed position relative to housing 110, with animaging surface parallel to the upper surface of housing 110, or it canrotate or pivot relative to housing 110 as described above. FIG. 7illustrates receptor 112 in one extreme of its rotation or pivoting. Theother extreme is when its left side (as viewed in FIG. 7) is all the wayup against or close to the upper wall of housing 110 and its right sideis all the way down. In addition, FIG. 7 illustrates an anti-scattergrid 116 that can be moved out of the x-ray imaging beam, to theposition in which it is seen in FIG. 7, or forward so that it overliesthe imaging surface of receptor 112, by a grid motor control 118 undercommands by the operator or by a computer operating the x-ray imagingsystem. Typically, grid 116 is out of the imaging beam when receptor 112is rotating or pivoting inside housing 110 in the course of an x-raystudy, and is in the beam if receptor 112 remains in a fixed position inhousing 110 during x-ray exposure of the breast. For use in each of themodes described above, imaging receptor 112 can be the two-dimensional,Selenium-based, flat panel, digital detector available from the commonassignee and currently used in said system offered under the Seleniatrade name. To accommodate the refresh rate of a particular imagingreceptor, the timing of taking successive projection images in the CTmode and the tomosynthesis mode can be adjusted accordingly. Imagingreceptors that can take successive projection images at a faster ratecan be used if desirable. As another alternative, an imaging receptorthat cannot image the entire breast at the same time can be used byscanning the receptor relative to the breast to cover the entire breastin one or more sweeps.

In the tomosynthesis modes, a different patient shield can be used toprotect the patient, and/or a different trajectory for tube 108 can beused, such as disclosed in commonly assigned U.S. Pat. No. 7,245,694,hereby incorporated by reference. Such a patient shield is schematicallyillustrated as item 120 in FIG. 6.

When operating in the mammography mode M, the system of FIGS. 5 and 6maintains imaging receptor 112 inside housing 110 fixed relative to bothx-ray source 108 and breast immobilized in unit 104. For taking a CCmammogram Mp, the source can be in the position seen in FIGS. 5 and 6.To take an MLO mammogram Mp, the patient's breast is released from unit104, gantry 106 rotates about the central axis of axle 102 as a unit,together with unit 104, and the patient's breast is again immobilized inunit 104, in a manner analogous to that used in conventional mammographyand with said system offered under the Selenia trade name.

Alternatively, as in the tomosynthesis mode of the system, lower plate104 b can be removed and the breast can be immobilized between the uppersurface of receptor housing 110 and upper plate 104 a. Typically, thex-ray dose to the patent for taking a mammogram Mp is significantlyhigher than for taking any one of the tomosynthesis projection imagesTp. For example, the dose for one mammogram Mp is the same or comparableto the total dose for all the images Tp taken in one sweep of x-raysource 108 through its arc. As in the tomosynthesis mode, the sameconcave plates 104 a and 104 b can be used, or generally flat plates canbe substituted, of the type used in said system offered under theSelenia trade name, and the upper surface of housing 110 can substitutefor lower plate 104 b.

In some or all of the modes, the coronal cross-section of the breastimmobilized in unit 104 can be approximately elliptical, as illustratedfor breast 122 in FIG. 8, such that the width of the immobilized orcompressed breast 122 is significantly more than its thickness. In thatcase, as seen in FIG. 8, the path length “a” along line A through breast122 is shorter than path length “b” along line B for x-rays within theimaging beam. To accommodate this situation, it can be desirable to varythe spectrum of the x-rays with angle of the imaging beam relative tothe breast. For example, softer x-rays can be used for path “a” than forpath “b” in order to improve the x-ray image. To this end, the systemwhen used in the CT mode or in the tomosynthesis modes, and with abreast 122 immobilized to a cross-section that is significantly widerthat thick, can be operated under computer control to vary the x-raybeam hardness accordingly, for example by varying the voltage (kV)driving x-ray tube 108. It can be important for a health professional toview concurrently images of a patient's breast or breasts taken withdifferent x-ray modalities. The system disclosed in this patentspecification provides that opportunity as it can produce CT images CTr,tomosynthesis images Tp and Tr, and mammograms M.

As illustrated in FIG. 9, the x-ray measurements that are obtained witha data acquisition system 124 that includes x-ray source 108 and imagingreceptor 112 operating as described above are provided to a console 126that includes an image processing unit configured to computer-processthe x-ray measurements (which can be in the form of projection imagesCTp, Tp and Mp) into image data for respective display images CTrd, Trdand Md for viewing, and for controlling data acquisition system 124 tooperate as described above. For clarity and conciseness, conventionalelements such as power supplies, operator controls and safety devices,are not illustrated. For tomosynthesis images and mammograms, theoperation of console 126 can be similar or identical to that used insaid system offered under the Selenia Dimensions trade name, or asdiscussed in said references cited above. For CTr images, the computerprocessing can operate as discussed in said U.S. Pat. No. 6,987,831. Formammograms, the processing can be as in said system offered uncle theSelenia trade name. The images resulting from the processing in console126 can be provided to a workstation 128, which can be the workstationoffered under the trade name SecurView by the common assignee, and/or toa display unit 130 that includes one or more computer display screens toshow, at the same time, two or more of the breast images. For example,display unit 130 can show at the same time, a CTrd image together with aTpd image and/or a Trd image, and/or an Mpd image. Any one of thesetypes of images can be shown as a single image, as two or more images,or in cine mode. For example, the Trd images can be shown in cine modechanging from an image of one breast slice to and image of anotherslice. The images displayed at the same time can be co-registered suchthat the selection of an anatomical feature in one of the concurrentlydisplayed images automatically identifies a matching anatomical featurein at least another one of the concurrently displayed images. If it isdesired to immobilize and position the breast for imaging using a devicedifferent from unit 104, data acquisition system 124 can include insteada device such as a cup-shaped or funnel-shaped breast receptor 104′(FIG. 10), into which the breast and possibly surrounding tissue can bepulled by means such as vacuum or adhesives, and such device can becontrolled by control 125 illustrated in FIG. 9. The cup or funnel wouldbe in place of unit 104, in the imaging beam from x-ray source 108.

FIG. 1.0 illustrates another embodiment, where a column 1000 pivots fromthe vertical about a pivot axis 1001 of a pivoting support 1002, forexample over a 10° angle as illustrated, so the patient can lean forwardagainst shield 1004. A rotating C-arm 1006 can carry an x-ray source 108emitting x-ray beam 109, and an x-ray imaging receptor housing 110, andcan be moved up and down column 1000 to match patients of differentheights, as in the embodiments described above. Shield 1004 shields thepatient from the x-ray source 108 as it rotates around breastcompression unit 104, and also shields the patient from any rotation ofx-ray imaging receptor housing 110. Shield 1004 further acts tostabilize the patient leaning against it, and may include handles thatthe patient may hold to further facilitate patient comfort andstability. Shield 1004 can surround that rotational trajectory of source108 and housing 110, and may include a front portion 1004 b that has anopening for the patient's breast, which opening may be sufficientlylarge to allow a health professional to reach in to adjust the breast asit is being compressed. Shield 1004 may further include a breastplatform that is between housing 110 and a portion of breast compressionunit 104, on which the patient's breast may rest and be compressed by apaddle on the other side of the breast, particularly for the CT mode ofoperation but possibly in other modes as well. The breast platform canbe flat, or it can be shaped to the contour of a breast (e.g., theplatform can be concave), and can be made in different sizes that can bechanged from one patient to another. An alternative shield 1004 can beused instead of or in addition to shield 1004. Shield 1004 a surroundscompression unit 104 (104′), and preferably includes a portion 1004 bthat also protects the patient from motion of gantry 1006. Some OF allof portion 1004 b may be removable, particularly for taking mammogramsM.

FIG. 11 illustrates another example, which is otherwise similar to thatof FIG. 10 but has a differently shaped patient shield 1004 d, which canbe supported on axle 102, and can include a front portion 1004 b′ thatis similar in position and function to portion 1004 b in FIG. 10 but issomewhat differently shaped. As with shield 1004, shield 1004 d caninclude a breast platform that is flat or shaped and can be in differentsizes and can include patient handles. An alternative shield 1004 e canbe used in addition to or instead of shield 1004 d, which has adifferent shape from shield 1004 a but serves a similar purpose. Theexample of FIG. 12 allows greater freedom for positioning the patient'slower body relative to the x-ray system that shield 1004.

The above specific examples and embodiments are illustrative, and manyvariations can be introduced on these examples and embodiments withoutdeparting from the spirit of the disclosure. For example, elementsand/or features of different illustrative embodiments described abovemay be combined with each other and/or substituted for each other withinthe scope of this disclosure.

Thus, this patent specification describes a multi-mode x-ray system forimaging a breast of an upright patient comprising: a breastimmobilization unit configured to immobilize a breast of an uprightpatient; an x-ray source on one side of a patient's breast immobilizedin said unit and an x-ray imaging receptor on the other side of thebreast, said source selectively emitting an imaging beam of x-rays andsaid receptor receiving said imaging beam, and said source and receptorbeing mounted for selective movement about the breast; an x-ray dataacquisition unit coupled with said source and receptor and configured toselectively operate said system in a CT mode in which the source andreceptor move about the immobilized breast of the upright patientthrough a CT angle of at least 180° and the receptor generates imagedata for a plurality of projection images CTp of the breast taken atdifferent angles within said CT angle; an image processing unitconfigured to receive and computer-process at least some of said imagedata for said images CTp to thereby generate reconstructed images CTrrepresenting slices of the breast having selected thicknesses andorientations, and to produce display slice images CTrd based thereon;and a display unit receiving said selectively displaying said displayimages CTrd for viewing.

The x-ray data acquisition unit can be further configured to selectivelyoperate the system in a tomosynthesis mode T rather than in the CT mode,in which mode T the source traverses angular positions relative to thebreast through a tomosynthesis angle T that is less than 180° and thereceptor generates tomosynthesis projection images Tp of the breasttaken at different angular positions of the source within said angle T;the image processing unit can be further configured to receive andcomputer-process at least some of the image data for images Tp tothereby generate reconstructed images Tr representing slices of thebreast having selected thicknesses and orientations, and to producedisplay slice images Trd and display projection images Tpd based on theimage data for the images Tp; the display unit can be further configuredto selectively display said display images Tpd, Trd and CTrd; and thedata acquisition and display units being further configured to selectthe CT mode or the tomosynthesis mode for operation.

The tomosynthesis mode can comprise a narrow-angle tomosynthesis mode Tnand a wide-angle tomosynthesis mode Tw, wherein: the x-ray dataacquisition unit is further configured to selectively operate (i) in themode T by causing at least the source to traverse angular positionsrelative to the breast through a relatively narrow angle and to causethe receptor to generate tomosynthesis projection images Tpn of thebreast taken at different angular positions within the narrow angle, and(ii) in the mode Tw by causing at least the source to traverse angularpositions relative to the breast through a relatively wide angle, widerthan the narrow angle, and to cause the receptor to generatetomosynthesis projection images Tpw of the breast taken at differentangular positions of the source within the angle Tw; the imageprocessing unit is further configured to receive and computer-process atleast some of the image data for images Tpn and Tpw to thereby generatereconstructed images Tr representing slices of the breast havingselected thicknesses and orientations, and to produce display sliceimages Trd and display projection images Tpnd and/or Tpwd based on theimage data for projection images Tpn and/or Tpw; the display unit isfurther configured to selectively display the display images Tpnd, Tpwd,Trd and CTrd; and the data acquisition and display units are furtherconfigured to select a mode of operation among the CT, Tn and Tw modes.

The x-ray data acquisition unit can be further configured to selectivelyoperate the system in a mammography mode M, rather than in the CT modeor the tomosynthesis mode T, to thereby generate M image data far one ormore projection mammograms Mp, each at a higher patient x-ray dose thana single one of the images Tp; the image processing unit can be furtherconfigured to receive and computer-process at least some of the imagedata for the one of more images Mp to thereby generate one or moredisplay mammogram image Mpd; the display unit can be further configuredto selectively display the display images Tpd, Trd, CTrd and Mpd; andthe data acquisition and display units being further configured toselect the CT, T or M mode of operation.

The data acquisition unit can be configured to vary the hardness of theimaging beam of x-rays with movement of the source relative to thebreast at least in one of the CT and T modes of operation.

The breast immobilization unit can comprise an upper plate and a lowerplate facing each other, wherein the facing portions of the plates areconcave where engaging the breast for immobilizing the breast.

The display unit can be configured to concurrently display at least oneof the images CTrd and at least one of the images Tpd and Trd inco-registration such that the selection of an anatomical feature in oneof the concurrently displayed images automatically identifies a matchinganatomical feature in at least another one of the concurrently displayedimages.

The data acquisition unit includes a shield separating the patient fromthe moving source and x-ray receptor in each of said modes of operationwhile permitting the breast to remain immobilized between the platformand paddle.

In another preferred embodiment, an x-ray system for imaging acompressed breast of a patient with x-rays comprises: a breastimmobilization unit configured to compress a patient's breast; an x-raysource on one side of the immobilization unit and an x-ray imagingreceptor on the other side, mounted for movement about a breastcompressed in said unit, x-ray data acquisition unit coupled with thesource and receptor and configured to operate the system in a CT mode inwhich the source and receptor move about the breast through an angle ofat least 180°, and the x-ray receptor generates image data for aplurality of projection images CTp of the breast; an image processingunit configured to receive and computer-process at least some of theimage data for the images CTp and computer-process the received data togenerate reconstructed CT images CTr representing slices of the breasthaving selected thicknesses and orientations, and to produce displayslice images CTrd based thereon; and a display unit receiving andselectively displaying the display images CTrd for viewing.

The immobilization unit can be configured to compress the breast of anupright patient.

The compressed breast can have a dimension in a first direction that issubstantially less than in a second direction that is transverse to thefirst direction, and the data acquisition unit can be configured to varythe hardness of the imaging beam of x-rays with movement of the sourcerelative to the breast so that the x-ray beam is harder when the x-raysare closer to the second direction than to the first direction.

The x-ray source can comprise an x-ray tube and the data acquisitionsystem can be configured to vary the hardness of the imaging beam byvarying a selected characteristic of electrical power driving the x-raytube. The selected characteristic can be a voltage (kV) of the powerdriving the x-ray tube.

In yet another preferred embodiment, the disclosed invention can be anx-ray system for imaging a patient's breast comprising: an upper an alower plates facing each other and configured to immobilize a patient'sbreast; each of said plates having a breast-engaging surface that isconcave where engaging the compressed breast; an x-ray source on oneside of said plates, and an x-ray imaging receptor on the other side,wherein at least said source is mounted for movement about the breast; adata acquisition unit coupled with the source and receptor andconfigured to cause the source to selectively generate an imaging x-raybeam at each of a plurality of angles of the source relative to thebreast and to cause the receptor to generates image data for a pluralityof projection x-ray images of the breast; an image processing unitconfigured to receive and computer-process at least some of the receiveddata to generate display images of the breast; and a display unitreceiving said selectively displaying said display images for viewing.In this system, the data acquisition unit can be further configured tocause the x-ray beam to have an x-ray hardness that varies depending onthe angle of said beam relative to the breast.

Yet another embodiment is a multi-mode x-ray tomosynthesis system forimaging a patient's breast comprising: a breast immobilization unitconfigured to immobilize a patient's breast; an x-ray source on one sideof the immobilization unit and an x-ray imaging receptor on the otherside; at least the x-ray source being mounted for movement about theimmobilized breast; an x-ray data acquisition unit coupled with thesource and receptor and configured to operate the system selectively in(i) a pre-set narrow angle tomosynthesis mode Tn, and (ii) a pre-setwide angle tomosynthesis mode Tw, wherein (a) in the Tn mode at leastthe source traverses angular positions relative to the breast through arelatively narrow angle Tn and the receptor generates image data fortomosynthesis projection x-ray images Tpn of the breast within saidangle Tn, and (b) in the Tw mode at least the source traverses angularpositions relative to the breast through a relatively wide angle Tw andthe receptor generates image data for a second plurality oftomosynthesis projection x-ray images Tpw of the breast within the angleTw; an image processing unit configured to receive and computer-processat least some of the image data for the images Tpn and Tpw toselectively generate display images of (i) at least some of said imagesTpn and Tpw and (ii) reconstructed tomosynthesis images Tr derived fromimage data for at least some of the images Tpn and Tpw and representingslices of the breast of selected thicknesses and orientations; and adisplay system selectively displaying sets of one or more of saiddisplay images for viewing; wherein the data acquisition and displayunits are further configured to select a Tn or Tw mode of operation.

Yet another embodiment is a multi-mode x-ray system for imaging apatient's breast comprising: a breast immobilization unit configured toimmobilize a patient's breast; an x-ray source on one side of theimmobilization unit and an x-ray imaging receptor on the other side,mounted for movement about the immobilized breast; an x-ray dataacquisition unit coupled with the source and receptor and configured tooperate said system selectively in (i) a narrow angle tomosynthesis modeTn, (ii) a wide angle tomosynthesis mode Tw, (iii) a computerizedtomography (CT) mode, and (iv) a mammography mode M, wherein: (a) in theTn mode at least the source traverses a first plurality of angularpositions relative to the breast through a relatively narrow angle andthe receptor generates image data for a first plurality of tomosynthesisprojection x-ray images Tpn of the breast, (b) in the Tw mode at leastthe source traverses a second plurality of angular positions relative tothe breast through a relatively wide angle and the receptor generatesimage data for a second plurality of tomosynthesis projection x-rayimages Tpw of the breast; and (c) in the CT mode, the source and thereceptor rotate about a length of the breast through an angle greaterthan said wide angle, and the receptor generates image data for a thirdplurality of projection images CTp of the breast, wherein the images CTpare greater in number than the images in each of the pluralities ofimages Tpn and Tpw, and (d) in the M mode the source and the receptorgenerate one or more projection images Mp of the breast, using for eachof said images Mp a patient x-ray dose greater than for any one of theimages Tpn and Tpw; an image processing unit configured to receive atleast some of said image data and computer-process the received data togenerate display images of at least some of (i) said projection imagesTpn and/or Tpw, (ii) reconstructed tomosynthesis images Tr derived fromimage data for at least some of said projection images Tpn and/or Tpwand representing slices of the breast having selected thicknesses andorientations, (iii) reconstructed CT images CTr representing slices ofthe breast having selected thicknesses and orientations, and (iv) one ormore mammograms Mp representing projection images of the breast; and adisplay system selectively displaying sets of one or more of saiddisplay images for viewing.

Yet another embodiment is a multi-mode x-ray system for imaging apatient's breast comprising: a breast immobilization unit configured toimmobilize a patient's breast; an x-ray source on one side of theimmobilization unit and an x-ray imaging receptor on the other side,mounted for movement about the immobilized breast; a x-ray dataacquisition unit coupled with said source and receptor and configured tooperate said system to generate image data for projection images takenat different angles of at least the x-ray source relative to the breast;an image processing unit configured to receive at least some of saidimage data and to computer-process the received data to generate CTslice images of the breast representing slices of the breast havingselected thicknesses and orientation and to further generate at leastsome of (i) tomosynthesis projection images Tp, and (ii) tomosynthesisslice images Tr reconstructed from at least some of the image data forsaid images Tp and representing slices of the breast having selectedthicknesses and orientations; and a display system selectivelydisplaying at least one or more of said CT images said Tp and Tr imagesfor viewing.

Yet another embodiment is an x-ray system for imaging a breast of apatient comprising: an x-ray source and an x-ray imaging receptormounted for movement about a position for a patient's breast such thatan imaging x-ray beam impinges on the receptor after passing through thebreast; an x-ray data acquisition unit coupled to the source and thereceptor and configured to cause at least the source to move todifferent angular positions relative to the breast and emit an imagingx-ray beam at each angular position and to cause the receptor togenerate image data for projection images taken at said angularpositions; said data acquisition unit being further configured to causethe x-ray hardness of said imaging x-ray beam to vary with movement ofthe source from one a said angular positions to another; an imageprocessing unit configured to receive at least some of said image dataand computer-process the received data to generate display images of thebreast derived from said projection images; and a display systemreceiving said selectively displaying said display images for viewing.

Yet another embodiment is a system for acquiring and displaying forconcurrent viewing co-registered x-ray CT images and other x-ray imagesof a patient's breast comprising: a source of x-ray image datadescribing (1) CT slice images representing first slices of a patient'sbreast and (ii) non-CT x-ray images of the breast; an image processingunit configured to receive at least some of said image data and generatetherefrom (i) display CT images of slices of the breast and (ii) non-CTdisplay images of the breast; and a a display unit configured to displayfor concurrent viewing at least one of said display CT images and atleast one of said non-CT display images; said display unit being furtherconfigured to cause said concurrently displayed images to beco-registered such that a mark placed by the system or user at ananatomical feature on one of the displayed images automatically appearsat a matching anatomical feature of at least one other concurrentlydisplayed image.

An embodiment of a method of breast imaging according to the disclosureabove comprises: compressing a breast of an upright patient between a anupper plate and a lower plate; providing an x-ray source on one side ofsaid plates and an x-ray imaging receptor on the other side; selectivelyimaging the patient's compressed breast with x-rays from: the x-raysource received at the x-ray receptor after passage through the breastin: (a) a narrow angle tomosynthesis mode generating a plurality oftomosynthesis projection x-ray images Tpn of the compressed breast takenover a relatively narrow extent of respective different angles of thex-ray source relative to the breast, (b) a wide angle tomosynthesis modegenerating a plurality of tomosynthesis projection images Tpw of thecompressed breast taken at a relatively wider extent of respectivedifferent angles of the x-ray source relative to the breast, (c) acomputerized tomography (CT) mode generating a plurality of CT images ofthe compressed breast taken while the x-ray source and the x-ray imagingmove around the breast over an angle greater than said relatively widerextent, and (d) a mammography mode generating one or more projectionimages Mp of the compressed breast, each using a patient doseapproximating that for a conventional mammogram; selectively moving thex-ray source and the x-ray imaging receptor in a direction generallyalong a length of the compressed breast from a position for one of saidmodes to a position for another of said modes; varying the x-ray sourcekV with the angle of the x-ray source relative to the breast whiletaking said images Tpw and/or said CT images; selectivelycomputer-processing said images Tpn and Tpw to produce reconstructedtomosynthesis images Tr of selected slices of said breast; anddisplaying selected combinations of one or more of said Tpn, Tpw, Tr andCT images for concurrent viewing.

1-40. (canceled)
 41. A system for imaging a breast of an upright patientwith x-rays comprising: a breast compression unit configured to at leastpartially compress a breast of an upright patient between a pair ofcompression surfaces; an x-ray data acquisition unit configured tooperate the system in: a computerized tomography (CT) mode to therebygenerate a plurality of CT x-ray projection images CTp of the breasttaken at different angles to the breast; and a tomosynthesis mode T tothereby generate a plurality of tomosynthesis x-ray projection images Tpof the breast taken at different angles to the breast; and an imageprocessing unit configured to computer-process the images CTp to therebygenerate a reconstructed image CTr and to computer process the images Tpto thereby generate tomosynthesis reconstructed breast slice images Trof at least a portion of the breast.
 42. The system of claim 41, furtherincluding a patient shield secured to the system and forming a barrierbetween the upright patient and moving elements of the system whenoperating in the CT mode.
 43. The system of claim 42, in which thepatient shield is configured to tilt to an inclined position in whichthe upright patient can lean forward against the shield.
 44. The systemof claim 42, in which the shield includes handles for the patient tohold to facilitate comfort and stability while the patient's breast isbeing imaged.
 45. The system of claim 41, in which the x-ray dataacquisition comprises an x-ray source that is configured to rotatearound the breast over a first angle for generating the projectionimages Tp and through a second angle that is greater than the firstangle for generating the projection images CTp.
 46. The system of claim45, in which the second angle is at least 180 degrees.
 47. The system ofclaim 41, in which the x-ray data acquisition unit is further configuredto vary hardness of x-rays impinging on the breast with change in theangle at which the projection images CTp are taken.
 48. The system ofclaim 41, in which the x-ray data acquisition unit is further configuredto selectively operate the system in a mammography mode M to therebygenerate one or more projection mammograms Mp, wherein each image Mp istaken at a higher patient x-ray dose than a single one of the images Tp.49. The system of claim 41, further comprising a display unit configuredto concurrently display at least one of the images CTr and at least oneof the images Tp and Tr in co-registration such that the selection of ananatomical feature in one of the concurrently displayed imagesautomatically identifies a matching anatomical feature in at leastanother one of the concurrently displayed images.
 50. The system ofclaim 41, in which the x-ray data acquisition system comprises an x-raysource and an x-ray imaging receptor moving in a direction generallyalong a length of the breast from a position for one of said modes to aposition for another of said modes.
 51. The system of claim 41, in whichthe x-ray data acquisition unit is further configured to operate in saidmode T by responding to an input to select between (i) a narrow anglemode Tn in which the projection images Tp are taken at angles over arelatively narrow angle Tn to thereby form a set of images Tpn of thebreast, and (ii) a wide angle mode Tw in which the projection images Tpare taken over an angle Tw that is wider than Tn to thereby form a setof images Tpw of the breast
 52. A system for imaging a breast of anupright patient with x-rays comprising: a breast compression unitconfigured to at least partially compress a breast of an uprightpatient; an x-ray data acquisition unit comprising an x-ray sourceemitting an imaging x-ray beam toward an x-ray imaging receptor andconfigured to operate the system in a computerized tomography (CT) modeto take CT x-ray projection images CTp of the upright patient's breasttaken at different angles of the imaging x-ray beam to the breast; asupport for the x-ray tube and the x-ray receptor configured to tilt toa position in which the imaging x-ray beam is tilted away from thevertical, causing the patient to lean into the data acquisition unit forimaging the patient's breast while remaining generally upright.
 53. Thesystem of claim 52, in which said x-ray data acquisition unit is furtherconfigured to operate in a tomosynthesis mode T to take tomosynthesisx-ray projection images Tp of the breast taken at different angles ofsaid imaging x-ray beam to the breast.
 54. The system of claim 52,further comprising a reconstruction unit configured to reconstructimages CTr of the breast from the CTp images and images Tr from theimages Tp, and a display unit configured to concurrently display atleast one of the images CTr and at least one of the images Tp and Tr inco-registration such that the selection of an anatomical feature in oneof the concurrently displayed images automatically identifies a matchinganatomical feature in at least another one of the concurrently displayedimages.
 55. The system of claim 52, further including a patient shieldsecured to the system and forming a barrier between the upright patientand moving elements of the system when operating in the CT mode.
 56. Thesystem of claim 55, in which the shield includes handles for the patientto hold to facilitate comfort and stability while the patient's breastis being imaged.
 57. The system of claim 52, in which the x-ray dataacquisition system further comprises handles for the patient to hold tofacilitate comfort and stability while the patient's breast is beingimaged.
 58. The system of claim 52, in which the x-ray data acquisitionsystem is configured to vary hardness of the imaging x-ray beam with theangle at which the projection images CTp are taken.
 59. A method ofimaging a breast of an upright patient with an x-rays system comprising:at least partially compressing the breast into a non-circularcross-section; responding to a selection signal to image the breast withx-rays either in either one or in both of the following modes: (a) acomputerized tomography (CT) mode generating a plurality oftwo-dimensional projection x-ray images CTp of the breast taken atrespective CT angles of an imaging x-ray beam to the breast; and (b) atomosynthesis mode T generating a plurality of two-dimensionaltomosynthesis projection x-ray images Tp of the breast taken atrespective tomosynthesis angles of the imaging x-ray beam to the breast;reconstructing images CTr of the breast from said images CTp and slicetomosynthesis images Tr of the breast from said images Tp; anddisplaying selected combinations of two or more of said CTr, Tp, and Trimages for concurrent viewing in co-registration.
 60. The method ofclaim 59, further comprising tilting the imaging x-ray beam to a tiltedposition in which the upright patient leans away from a verticalposition